Isle of Wight Council COVID-19 Local Outbreak Management Plan 2021

Total Page:16

File Type:pdf, Size:1020Kb

Isle of Wight Council COVID-19 Local Outbreak Management Plan 2021 Isle of Wight Council COVID-19 Local Outbreak Management Plan 2021 Version 1.0 Final IWC COVID-19 Local Outbreak Management Plan 2021 Page 1 of 35 Foreword In line with the next phase of the UK’s response to the COVID-19 pandemic, the Isle of Wight Council (IWC) is required to review and update the Local Outbreak Plan. This 2021 update plan details how the Council and its partners will respond to further outbreaks of infection and covers the key aspects. The full IWC Incident and Outbreak Control Plan can be found on the IWC Outbreak Management webpage. Our aim We want Isle of Wight residents to be able to live healthy and productive lives. But we need to achieve this in a way that is safe, protects our health and care services and enables the local economy to restart and thrive as we manage the response to the COVID-19 pandemic and learn to live with COVID-19. We aim to: • Reduce the transmission of COVID-19, protecting all, especially those who are most vulnerable, and preventing increased demand on our health and care services. • Provide consistent advice to places and communities to prevent the spread of COVID-19. • Oversee the NHS test and trace programme on the Isle of Wight and its working with the Isle of Wight Local Tracing Service, and coordinate testing across the Island. • Oversee the implementation of the local COVID vaccination programme across the Isle of Wight. • Work together with partners, in a coordinated way, to support communities across the Island to reduce the spread of infection and ensure that the most vulnerable have access to the support they need. This Local Outbreak Management Plan should be read in conjunction with the IWC COVID-19 Prevention, Incident and Outbreak Control Plan and settings based action plans available on the IWC website. IWC COVID-19 Local Outbreak Management Plan 2021 Page 2 of 35 Document Control This plan is authored and maintained by Isle of Wight Council Public Health. Version Date Remark(s) Author 0.1 11/03/2021 Initial draft SB (draft) 0.2 15/03/2021 Updated with additional information SB/ BH (draft) 0.3 25/03/2021 Updated with additional information SB/BH (draft) 1.0 30/03/2021 Updated with additional information SB FINAL Date Published: 31/03/2021 Document Review The IWC COVID-19 Outbreak Management Plan 2021 will be reviewed on a quarterly basis unless learning from an incident or outbreak requires it to be reviewed sooner. The original IWC COVID-19 Prevention, Incident and Outbreak Control Plan remains available on Council website for reference. Document Distribution • Isle of Wight Council GOLD • Members of the Isle of Wight Local Outbreak Engagement Board • Members of the Isle of Wight Health Protection Board • Hampshire and Isle of Wight Integrated Care System • Hampshire and Isle of Wight Local Resilience Forum • Isle of Wight Health and Wellbeing Board IWC COVID-19 Local Outbreak Management Plan 2021 Page 3 of 35 Contents Page Foreword .............................................................................................................................. 2 Document Control ................................................................................................................ 3 Contents Page ..................................................................................................................... 4 Section 1 – Background information .................................................................................... 6 1.1 Isle of Wight Context ...................................................................................................... 6 1.2 COVID-19 objectives ..................................................................................................... 6 1.3 Governance ................................................................................................................... 8 1.3.1 IWC COVID-19 Local Outbreak Engagement Board (LOEB)...................................... 9 1.3.2 IWC Health Protection Board .................................................................................... 10 1.3.3 Hampshire and Isle of Wight Local Resilience Forum ............................................... 10 1.5 Local authority and public health protection powers .................................................... 11 Section 2 – the COVID-19 Response ................................................................................ 12 2.1 Adult care settings including care homes ..................................................................... 12 2.2 Schools, education and childrens’ care settings .......................................................... 12 2.3 High risk places, locations, communities and healthcare settings ................................ 13 2.4 Local testing programmes ............................................................................................ 14 2.4.1 Asymptomatic testing at scale ................................................................................... 15 2.4.2 Optimising testing capacity ....................................................................................... 15 2.5 Contact tracing ............................................................................................................. 16 2.5.1 Enhanced contact tracing.......................................................................................... 16 2.5.2 Designated Venues ................................................................................................... 17 2.5.3 Local tracing partnerships ......................................................................................... 17 2.6 Self Isolation ................................................................................................................ 18 2.7 Vulnerable people ........................................................................................................ 19 2.8 Outbreak management and Variants of Concern ......................................................... 20 2.8.1 Surge capacity management locally to respond to outbreaks, including of a (VOC) . 21 2.9 Enduring transmission ................................................................................................. 22 2.10 COVID safe ................................................................................................................ 22 2.11 Vaccinations............................................................................................................... 23 2.11.1 Measures to improve vaccine uptake locally ........................................................... 23 2.11.2 Linkages between vaccine roll-out and testing ........................................................ 24 2.12 Compliance and enforcement .................................................................................... 24 IWC COVID-19 Local Outbreak Management Plan 2021 Page 4 of 35 2.13 Communications and engagement ............................................................................ 25 2.14 Surveillance ............................................................................................................... 26 2.15 Resourcing ................................................................................................................. 28 2.15.1 Capacity management ............................................................................................ 28 2.15.2 Management of impacts of the resumption of business as usual activities ............. 29 Section 3 Forward Planning ............................................................................................... 30 Appendix 1 – List of Acronyms........................................................................................... 32 Appendix 2 – Roles and Responsibilities ........................................................................... 33 IWC COVID-19 Local Outbreak Management Plan 2021 Page 5 of 35 Section 1 – Background information 1.1 Isle of Wight Context The Isle of Wight lies off the south coast of mainland England and covers an area of 380.16km2 (38,016 hectares, or 146.8 sq. miles). Newport, the second largest town by population, is the administrative centre, and is home to the Isle of Wight Council, St. Mary’s Hospital, courts and strategic command centres. The Isle of Wight has 39 Electoral Wards and 33 Town and Parish Councils. This plan, and the original IWC COVID-19 Prevention Incident and Outbreak Control Plan 2020 , identifies those at high risk of COVID-19 such as those over 70, from ethnic minorities or living with long term conditions. It also provides an understanding of high risk settings in the area (for example prisons and care homes) and identification of those populations who are least likely to access services, such as people from ethnic minority groups, people living in areas of deprivations or those not registered with a GP. IWC produce COVID-19 data packs which comprise of the latest information available from open sources related to COVID-19. The IWC, and its partner agencies, can use these packs to understand the potential population health needs, risks and vulnerabilities which exist within their own areas. The packs also includes information related to schools and care homes which are themes within the Local Outbreak Control Plan. In light of the 2nd wave of COVID-19 and the high transmissibility of the new variant, the data pack will be updated to include high risk settings such as HMP Isle of Wight. 1.2 COVID-19 objectives The main objective in managing an outbreak is to protect the public’s health.
Recommended publications
  • Herefordshire Primary Care Trust 2012-13 Annual Report and Accounts
    Herefordshire Primary Care Trust 2012-13 Annual Report and Accounts You may re-use the text of this document (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives.gov.uk/doc/open-government-licence/ © Crown copyright Published to gov.uk, in PDF format only. www.gov.uk/dh 2 Herefordshire Primary Care Trust 2012-13 Annual Report 3 Annual Report Herefordshire PCT 2012/13 Cover Front page (including appropriate PCT logo) Front inside cover (including content list) Back inside cover (including language statement) Back cover (including contact address, telephone number, website) Page 1 of 42 Message from Jo Newton –Chair of Herefordshire PCT This report details the activities of NHS Herefordshire (Herefordshire Primary Care Trust or PCT) undertaken during 2012/13. Prior to closure on 31st March 2013 the Board formally handed over its responsibilities to the new Clinical Commissioning Groups (CCGs), NHS England, and Herefordshire County Council and other bodies. The bulk of the PCTs’ commissioning responsibilities are being handed over to our CCGs, all of whom have recently become authorised as statutory organisations. In Herefordshire this will be Herefordshire CCG . The governance arrangements we made 12 months ago ensured a robust handover. All the emerging CCGs have been sub- committees of the West Mercia cluster of PCTs, with the CCG Chairs attending Board meetings. Through this process it has been very encouraging to witness the progress and achievements to date which I trust will continue. These arrangements, coupled with the progress the CCGs have made during the authorisation process, mean that I am sure the commissioning of health services for our local population is in safe hands.
    [Show full text]
  • The Powers and Duties of the Secretary of State for Health
    The powers and duties of the Secretary of State for Health Contents of this chapter: 1. Introduction 2. The Secretary of State’s Mandate to NHS England. 3. The general duties on the Secretary of State in Part 1 of the NHS Act. 4. The Public Sector Equality Duty. 5. The Secretary of State’s powers and duties to make Regulations. 6. The Secretary of State’s power to issue Directions. 7. The power of the Secretary of State to issue Guidance. 8. The role of the Secretary of State in the Trust failure regime. 9. Schedule 1 powers and duties. 10. The Emergency Powers of the Secretary of State. The abbreviations used in this chapter are: CCG Clinical Commissioning Group GP General Practitioner NHS Act National Health Service Act 2006 PbR Payment by Results under the NHS National Tariff STP Sustainability and Transformation Partnership TDA Trust Development Authority NHS England The National Health Service Commissioning Board 2012 Act Health and Social Care Act 2012 2012 Regulations National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 1. Introduction. 1.1 The Secretary of State sits at the pinnacle of the NHS with ultimate political responsibility for the performance of NHS. However, the Secretary of State is not a healthcare professional and may not have any NHS management experience. He or she will be a hugely experienced politician leading a public service where the personal is political. Thus the NHS needs the political skills of an astute Secretary of State just as the Secretary of State needs the technical and professional guidance of all those who advise him and her.
    [Show full text]
  • Events Are Free of Charge, and Open to the Public. ABOUT the SPEAKER, RICHARD HUMPHRIES Senior Fellow, the King’S Fund
    Public lecture In association with the RSA HOSPITALS AND HOME: Good Healthcare in Herefordshire by Richard Humphries and Martin Samuels Taking place in the Events Suite at the Hereford Campus, Herefordshire & Ludlow College, Folly Lane, Hereford on Tuesday 23 January 2018 Arrivals from 4.15pm, for a 4.30pm start, and a 6.00pm close Hospitals and care services are rarely out of the national news. Our ageing population is a cause for celebration, but the way we fund and organise the essential care and treatment most of us will need in later life hasn’t kept pace with that population. Richard Humphries, RSA Fellow and Visiting Professor at the University of Worcester will outline the national politics and policy. Martin Samuels, Director for Adults & Well-being at Herefordshire Council will describe the challenges in Herefordshire. The focus will be on sharing and comparing ideas and practical, local solutions that could improve health and social care services for Herefordshire’s citizens. To RSVP by Tuesday 17 January and to keep up-to-date with future lectures and events, please contact: E: [email protected] T: 01432 365 431 The Royal Society for the Encouragement of Arts, Manufactures and Commerce has a mission to enrich society through ideas and action. The RSA publishes over forty reports each year on subjects ranging from the future of our cities and communities, to schools, the economy and the reform of public services. All events are free of charge, and open to the public. ABOUT THE SPEAKER, RICHARD HUMPHRIES Senior Fellow, The King’s Fund Richard Humphries is a recognised national commentator and writer on the integration of health and social care, social care reform and the funding of long- term care.
    [Show full text]
  • Health Action Zones
    Health Action Zones - the engagement of the voluntary sector A report by Julia Unwin and Peter Westland August 2000 The Baring Foundation Contents Page 1. Introduction 1 2. The Context: a cascade of exhortation, consultation and regulation 3 3. Key findings 5 4. Descriptions of each area 16 5. The development of voluntary and community sector engagement 22 in each locality 6. Conclusion 28 Appendix 1 The engagement of the Wansbeck voluntary sector in the Northumberland Health Action Zone Appendix 2 List of people consulted Health Action Zones – the engagement of the voluntary and community sector Summary Health Action Zones require the involvement of the voluntary and community sector. This study, carried out over eighteen months, considers the ways in which this requirement has become a reality in two localities, and also considers a third area in less depth. It concludes that, while there is great willingness and enthusiasm for partnership in both the voluntary and statutory sectors, this enthusiasm has been tempered by experience and, in some cases, blunted. The capacity of voluntary and community organisations requires considerable development if they are to play a full and effective role. Equally, statutory planners and managers who need no convincing about the potential benefits of voluntary and community sector engagement need assistance in devising effective ways of achieving it. Without this, both sectors suffer from "partnership fatigue" and a sense that the costs are great for limited benefits. In the period studied, a number of obstacles to full engagement were being tackled. At the same time, the expectations faced by both voluntary and statutory sectors have changed.
    [Show full text]
  • North East Strategic Health Authority 2012-13 Annual Report and Accounts
    North East Strategic Health Authority 2012-13 Annual Report and Accounts October 2013 You may re-use the text of this document (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives.gov.uk/doc/open-government-licence/ © Crown copyright Published to gov.uk, in PDF format only. www.gov.uk/dh 2 North East Strategic Health Authority 2012-13 Annual Report 3 ANNUAL REPORT AND FINANCIAL STATEMENTS 2012/2013 North East Strategic Health Authority1 Part of NHS North of England Contents 1. Foreword from the Chair and Chief Executive 3 2. Strategic priorities and progress 3 - About NHS North of England 5 - Commissioning development 9 - Quality, innovation, productivity and prevention (QIPP) 12 - Clinical networks 12 - Public health 14 3. Access to services and improved facilities 15 - New health service facilities 15 - Performance against key standards 17 4. Quality and patient safety 24 - Learning lessons from serious accidents 26 - Safeguarding adults and children 27 - Information technology supporting healthcare 28 - Information governance 29 5. Workforce development 31 - Education, training and development 31 - Partnerships in education and learning 33 - Workforce planning 34 - Workforce transition 35 6. Communications and engagement 37 - London 2012 – Olympic legacy 37 - Media relations 37 - Parliamentary liaison 38 - Campaigns 38 7. Corporate accountability, governance and finance 39 - Planning for emergencies 39 - Human resources 40 - Sustainability
    [Show full text]
  • Lancashire Teaching Hospitals NHS Foundation Trust Annual Report and Accounts 2019–20
    Lancashire Teaching Hospitals NHS Foundation Trust Annual Report and Accounts 2019–20 @LancsHospitals Lancashire Teaching Hospitals NHS Foundation Trust Annual Report and Accounts 2019-20 Presented to Parliament pursuant to schedule 7, paragraph 25(4) (a) of the National Health Service Act 2006 ©2020 Lancashire Teaching Hospitals NHS Foundation Trust CONTENTS • Overview 1 • Chairman’s and Chief Executive’s Welcome • Performance report 4 • Overview of performance 5 • Performance analysis 11 • Accountability report 20 • Directors’ report 21 • Remuneration report 53 • Staff report 65 • Disclosures set out in the NHS Foundation Trust Code of Governance 82 • NHS Improvement’s Single Oversight Framework 87 • Statement of accounting officer’s responsibilities 88 • Annual governance statement 90 • Council of Governors’ report 114 • Membership report 119 • Audit Committee report 124 • Quality report 131 • Financial review 239 • Independent auditors’ report to the Council of Governors on the financial statements 240 • Foreword to the accounts 250 • Statement of comprehensive income 251 • Statement of financial position 252 • Statement of changes in equity for the year 253 • Statement of cash flows 254 • Notes to the accounts 255 This symbol indicates that more information is available on our website: www.lancsteachinghospitals.nhs.uk Cover photograph: Caroline Watson, Health Care Assistant and Dr Rajesh Kumar, Associate Consultant in Anasethetics CHAIRMAN’S AND CHIEF EXECUTIVE’S WELCOME Welcome to our annual report for the financial year 2019-20, which sets out our achievements, activity and performance. The annual report is also an opportunity to share our vision and priorities at a time of significant pressure and change within the NHS. Well what a year 2020 has been so far! Clearly we are all living in very strange and uncertain times at the moment due to the Coronavirus (Covid-19) pandemic.
    [Show full text]
  • South Central Strategic Health Authority 2012-13 Annual Report and Accounts
    South Central Strategic Health Authority 2012-13 Annual Report and Accounts You may re-use the text of this document (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives.gov.uk/doc/open-government-licence/ © Crown copyright Published to gov.uk, in PDF format only. www.gov.uk/dh 2 South Central Strategic Health Authority 2012-13 Annual Report and Accounts 3 South Central Strategic Health Authority Annual Report 2012/13 The three Strategic Health Authorities (SHAs) in the South of England – South Central, South East Coast and South West – merged to form one SHA for the South of England in October 2011. However, three versions of the annual report have been produced because each individual SHA is a statutory body and therefore required to produce an annual report. Each report should be read in conjunction with the SHA handover documents: ● Maintaining and improving quality during transition: handover document ● Operational Handover and Closedown Report Chairman and Chief Executive’s Foreword This year has been a challenging and busy time for the NHS and the South of England has been no exception. As new NHS structures have emerged, staff have worked hard to set up new systems and develop new working relationships while continuing to deliver the demands of their current roles without interruption. All parts of the NHS across the South of England have worked together to sustain and improve the quality of services delivered and to leave a strong legacy so that all the new Chairman Dr Geoff Harris OBE Clinical Commissioning Groups will start without debt.
    [Show full text]
  • NHS Hambleton, Richmondshire and Whitby Clinical Commissioning Group
    NHS Hambleton, Richmondshire and Whitby Clinical Commissioning Group Annual Report 2019-2020 1 Introduction Welcome from Amanda Bloor, Accountable Officer North Yorkshire Clinical Commissioning Groups (NHS Hambleton Richmondshire and Whitby, NHS Harrogate and Rural District, NHS Scarborough Ryedale) Welcome to our annual report for the year which ends on 31 March 2020. This report highlights the work we have been doing this year to drive better healthcare outcomes for the people of Hambleton, Richmondshire and Whitby and to empower local people to take informed decisions about their own health and wellbeing in partnership with health professionals. This will be our last annual report as Hambleton, Richmondshire and Whitby CCG. As you will read in this report substantial work has been undertaken this year to bring together three North Yorkshire CCGs (Hambleton Richmondshire and Whitby CCG, Harrogate and Rural District CCG, and Scarborough and Ryedale CCG) as the North Yorkshire Clinical Commissioning Group from 1 April 2020. By coming together as a larger, strategic organisation we can transform how we deliver healthcare. This new approach to healthcare commissioning is great news for the people of North Yorkshire. It will enable closer collaboration and consistency of approach, enabling us to amplify the impact of our resources and expertise. This does not mean we will dilute either our clinical or local focus – both remain at the heart of how we will deliver for our communities. This year has seen a journey of significant change for the CCG. We received approval from NHS England to establish the Yorkshire Clinical Commissioning Group on 1 April 2020 in November last year.
    [Show full text]
  • Healthwatch Isle of Wight
    Healthwatch Isle of Wight A strong voice for local people on health and social care issues. We want to build an organisation that people value and use. Tell us your views. June 2012 1 Introduction What is Healthwatch and why do we want to involve you in its development? In March 2012, the government introduced a new law (the Health & Social Care Act 2012) requiring each local authority area to set up a new organisation called Healthwatch by April 2013. Healthwatch will help provide information and advice to Islanders about health and social care services, direct people to services (so they understand the choice of care available) and involve people in improving and shaping the services on which they rely. It will continue many of the roles formerly carried out both by the Local Involvement Network (LINk) which ceases to exist on 31 March next year and, before that, the Island’s community health council. Healthwatch will effectively act as a ‘consumer champion’, making the views and experiences of the local community known to the people making decisions about these services, both locally and nationally. The Isle of Wight Council is required to make sure it has a local Healthwatch organisation in place by April 2013 and we will receive funding from the government to enable us to do that. Some of the functions and roles that Healthwatch will need to perform have been set out in law but the government has also said that it wants local authorities to be able to make some of its own choices about how local Healthwatch is set up so the new organisation meets the Island’s particular needs.
    [Show full text]
  • Independent Investigation Into the Care and Treatment Provided to Mr
    Independent Investigation into the Care and Treatment Provided to Mr. X by Lancashire Care NHS Foundation Trust Commissioned by NHS North West Strategic Health Authority Independent Investigation: Health and Social Care Advisory Service Report Author: Alan Watson The Care and Treatment of Mr. X Contents 1. Investigation Team Preface Page 4 2. Condolences to the Family and Friends of Mr. A Page 5 3. Incident Description and Consequences Page 6 4. Background and Context to the Investigation Page 7 5. Terms of Reference Page 9 6. The Independent Investigation Team Page 11 7. Investigation Methodology Page 12 8. Information and Evidence Gathered Page 21 9. Profile of Lancashire Care NHS Foundation Trust Page 23 10. Chronology of Events Page 27 11. Timeline and Identification of the Critical Issues Page 42 12. Further Exploration and Identification of Causal and Page 51 Contributory Factors and Service Issues - 12.1.1. Diagnosis Page 52 - 12.1.2. Medication and Treatment Page 60 - 12.1.3. Management of the Clinical Care and Treatment Page 68 of Mr. X - 12.1.4. Use of the Mental Health Act (1983 & 2007) Page 74 - 12.1.5. The Care Programme Approach Page 77 - 12.1.6. Risk Assessment Page 84 - 12.1.7. Referral, Transfer and Discharge Page 88 - 12.1.8. Carer Assessment and Carer Experience Page 91 - 12.1.9. Service User Involvement in Care Planning Page 93 - 12.1.10.Documentation and Professional Page 95 Communication - 12.1.11. Clinical Supervision Page 100 - 12.1.13. Organisational Change and Professional Page 102 Leadership - 12.1.14.
    [Show full text]
  • 1 Independent Investigation Into the Care and Treatment Provided to Mr Y by the Cornwall Partnership NHS Foundation Trust, Cornw
    Independent Investigation into the Care and Treatment Provided to Mr Y by the Cornwall Partnership NHS Foundation Trust, Cornwall Council and Avon and Wiltshire Mental Health Partnership NHS Trust, Commissioned by NHS South West Strategic Health Authority Report prepared by the Health and Social Care Advisory Service Authored by: Helen Waldock Len Rowland Androulla Johnstone Ian Allured 1 CONTENTS Page 1. Investigation Team Preface 3 2. Condolences 4 3. Incident Description and Consequences 5 4. Background to the Independent Investigation 6 5. Terms of Reference 7 6. The Investigation Team 8 7. Findings 9 8. Contributory Factors, Service Issues and Recommendations 18 9. Profile of Cornwall Partnership NHS Foundation Trust 26 and Avon and Wiltshire NHS Partnership Trust (Past and Present) 2 1. Investigation Team Preface 1.1 The Independent Investigation into the care and treatment of Mr Y was commissioned by NHS South West pursuant to HSG (94)271. 1.2 This Investigation was asked to examine a set of circumstances associated with the death of Mr M. 1.3 Mr Y received care and treatment for his mental health condition from the Cornwall Partnership Mental Health Trust (Cornwall Partnership NHS Foundation Trust) and Avon and Wiltshire Mental Health Partnership NHS Trust. It is the care and treatment that Mr. Y received from these organisations that is the subject of this Investigation. 1.4 Investigations of this sort should aim to increase public confidence in statutory mental health service providers and to promote professional competence. The purpose of this Investigation is to learn any lessons that might help to prevent any further incidents of this nature and to help to improve the reporting and investigation of similar serious events in the future.
    [Show full text]
  • Public Consultation Cumbria County Council
    Cumbria County Council Developing Local Healthwatch and Independent Advocacy Service How to ensure a strong voice for local people on in Cumbria health and social care issues? Public consultation Cumbria County Council Consultation summary What are Local Healthwatch and the Independent Advocacy Service Cumbria County Council wants to hear your views and why do we want your views? about Cumbria’s new Local Healthwatch and Independent Advocacy Service. These are new Local Healthwatch organisations that are being set up to provide information, advice and support about health and In March 2012, the government introduced a new law social care services. (the Health & Social Care Act 2012) requiring each local authority area to set up a new organisation This document provides you with more information called Local Healthwatch. Cumbria County Council and highlights the issues where we are particularly is required to make sure it has a Local Healthwatch interested in your opinions. organisation in place by April 2013 and we will receive funding from the government to enable us to do that. You can respond to the consultation in the following ways: Healthwatch will: • By completing the online questionnaire at • help provide information and advice to people cumbria. gov.uk across Cumbria about health and social care • Completing the paper questionnaire at the end of services; this document • direct people to services (so they understand the • By emailing your views to [email protected] choice of care available); • In writing to Healthwatch Consultation, FREEPOST • and involve people in improving and shaping the NWW6059A, Cumbria County Council, Carlisle, services on which they rely.
    [Show full text]